Provider Demographics
NPI:1790767671
Name:GRUNTOWICZ, DON (PHARMD, BCPS, CGP)
Entity Type:Individual
Prefix:DR
First Name:DON
Middle Name:
Last Name:GRUNTOWICZ
Suffix:
Gender:M
Credentials:PHARMD, BCPS, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 WESTERN AVE STE 100
Mailing Address - Street 2:GENELEX CORPORATION
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-3017
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3101 WESTERN AVE STE 100
Practice Address - Street 2:GENELEX CORPORATION
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-3017
Practice Address - Country:US
Practice Address - Phone:206-302-8945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO164741835P1200X
WAPH600866141835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC1790767671Medicare PIN